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Health Services and Outcomes

Health services and outcomes research is the study of the relationships between people and their health care systems and health care providers, and the consequences of these interactions on their health.

Program Head: Dr. Jason Sutherland

Our network of health services researchers design, interpret, and report on evaluations of clinical practice, the organization and delivery of health care, quality and safety of health services, spending and costs of care. The team is experienced with linking health service use to patients’ and families’ outcomes to evaluate the efficiency, effectiveness, and quality of care.

There is a growing demand by governments, health systems, and patients for empirical evidence regarding the cost-effectiveness of health care spending. We provide the expertise to generate evidence to direct investments in the health system to maximize patients’ function, quality of life, minimize symptom burden, and improve experiences with the health care system and its providers. Moreover, patients’ perceptions regarding their own health are increasingly being reflected as important outcomes of processes of care.

Some examples of projects within this program are below.

Improving Care in the ICU

PHC researchers reduced the number of routine chest x-rays at St. Paul’s Hospital’s Intensive Care Unit (ICU), saving an estimated $27,000 a year and reducing patient exposure to harmful x-rays. The team, which included CHÉOS investigators Drs. Peter Dodek, Najib Ayas, and Hubert Wong, implemented a quality improvement intervention that included education and computer order entry that proved to be effective in reducing the number of chest x-rays without having a negative impact on patient outcomes or process of care. The study was published in BMJ Quality and Safety, and was reported on by The Vancouver Sun.

Increasing Access to Hospitals by Changing Financial Incentives

  • New pricing approaches for bundled payments: Leveraging clinical standards and regional variations to target avoidable utilization (Publication Link)
  • Pricing hospital care: Global budgets and marginal pricing strategies (Publication Link)
  • British Columbia’s pay-for-performance experiment: Part of the solution to reduce emergency department crowding? (Publication Link)

Coronary Revascularization: A Tool for Evidence-Based, Individualized, Shared Decision-Making (CR-Decide)

CR-Decide is a qualitative study that aims to develop an evidence-based, individualized, decision-making tool to support shared decision-making (SDM) between patients and physicians during treatment selection for stable coronary artery disease (CAD). Once the tool has been built, the study will then focus on integrating it into routine clinical care.

Led by PIs CHÉOS Scientist Dr. Karin Humphries and Dr. Colleen Norris, CR-Decide will engage over 150 stable CAD patients and cardiovascular health care professionals across B.C and Alberta in focus group sessions and interviews in order to assess the importance of different prognostic information, to prioritize relevant clinical and health-related quality of life outcomes, and to discuss potential implementation strategies.

Current evidence suggests that patients’ and physicians’ preferences, with respect to treatment options and prioritization of outcomes, differ. The study, therefore, endeavours to address this discrepancy by facilitating the inclusion of patient preferences in treatment decision-making.

Read more about the project at http://www.icvhealth.ca/portfolio/cr-decide-study/.

Measuring Self-Reported Health While Waiting to Access Surgical Treatment

  • Health of patients on the waiting list: Opportunity to improve health in Canada? (Publication Link)
  • Patient-reported outcomes and surgical triage: A gap in patient-centered care? (Publication Link)

Improving Patient Outcomes

  • Analyzing the 22-item Sino-Nasal Outcome Test using item response theory (Publication Link)
  • Time trends in hospital stay after hip fracture in Canada, 2004–2012: Database Study (Publication Link)
  • The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients (Publication Link)
  • Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis (Publication Link)
  • A randomized, controlled pragmatic trial of telephonic medication therapy management to reduce hospitalization in home health patients (Publication Link)

Health research in the heart of Vancouver